Allergies May Prevent Heart Attacks???

Research has been published suggesting an inverse relationship between serum IgE and heart attacks in the US population independent of coronary risk factors.

No kidding...

This conclusion was reached based analyzing 4002 participants between 2005-2006. They also detected that of the 7 "data-driven, prespecified allergen clusters," house dust mite was the only allergen cluster for which serum IgE is associated with reduced risk for heart attack.

For those wondering, serum IgE is a rough measure of how allergic a patient is generally speaking without any specification of what the patient may be allergic to. It is obtained by bloodwork (RAST or immunoCAP).

The higher the IgE levels, the more allergic a patient is generally speaking. However, one must keep in mind that it may still be possible to be allergic even if IgE is low or vice versa.

Also, although there appears to be a relationship between IgE and heart attacks, it is doubtful it reaches clinical significance for any given patient. Rather, such conclusions may apply to a general population. This study was also retrospective and as such, it would be nice if a new study now looked at a group of allergic patients and see how many suffer heart attacks in the future.

Such un-intuitive relationships just goes to show how complex the human body is where one thing doesn't cause one problem, but rather one thing may affect multiple different aspects of human health.

Now why would IgE and/or allergies in general influence heart attack risk?

Well heart attacks are due to vascular disease (blockage of the coronary artery). Vascular disease is thought to be influenced by how much inflammation is present in the body. The more inflammation present, the higher the risk of vascular disease which in turn increases heart attack rates.

One factor thought to influence the degree of inflammation present in the body is the immune system, and allergies is one part of the immune system.

As such, allergies could be a reflection of what the immune system is doing which in turn influences the degree of inflammation present in the body which in turn affects vascular disease which plays a role in heart attacks.

Reference:
Relation between objective measures of atopy and myocardial infarction in the United States. Journal of Allergy and Clinical Immunology. In Press Aug 27, 2012.

Child's Allergy Risk Higher If Same Sex Parent Has It

British researchers reported this month their findings that a child is at higher risk of allergies if the same sex parent has allergies. In other words, if a father has bad allergies, his sons are at higher risk for them and if a mother has bad allergies, than her daughters are at higher risk for allergy problems.

They based their findings following 1456 children examined at 1, 2, 4, 10, and 18 years of age. History of asthma, eczema, rhinitis, and environmental factors was obtained and skin prick tests were carried out at ages 4, 10, and 18 years, and total IgE measurement was carried out at 10 and 18 years. Parental history of allergic disease was assessed soon after the birth of the child, when maternal IgE levels were also measured.

Keep in mind that the appearance of allergy in a child is not wholly based on genetics but does have some environmental basis as well.

However, the association of gender is a new twist on whether a child will develop allergies or not.

Reference:
The effect of parental allergy on childhood allergic diseases depends on the sex of the child. The Journal of Allergy and Clinical Immunology Volume 130, Issue 2 , Pages 427-434.e6, August 2012

Head CT Scans Increase Risk of Cancer in Kids

By how much?

Brain tumor/cancer risk was 3X greater than the general population in children who received two to three CT scans of the head.

And the chance of developing leukemia was three times as great for children who received five to 10 CT scans of the head.

In the study published in Lancet, the researchers examined 176,587 children who had received a CT scan before age 22 and looked at their medical history for an average of 10 years afterward.

Though the risk sounds "high," the overall risk is still relatively small and CT scans should still be performed if medically warranted.

Phrased another way, the risk corresponds to one additional case of leukemia in the 10 years after the first scan for every 10,000 patients younger than 10 who were scanned or an extra case of brain cancer for every 30,000 children scanned.

Even so, the study does illustrate that CT scans should not be ordered unless there's a very good reason to do so, especially in children given they are more radiosensitive compared to adults.

In the ENT world, the most common reason to order a CT scan is to evaluate for sinusitis.

My own personal preference is to obtain one in children if and only if all other sinusitis interventions have already been performed.

Such "sinusitis" interventions include:

• Allergy intervention (steroid and/or anti-histamine nasal sprays)
• Failure to respond to antibiotics
• Adenoidectomy (if large adenoids present which can be determined on endoscopy)
• Turbinate Reduction (if turbinates are enlarged)
• Check for cystic fibrosis and primary ciliary dyskinesia

If above interventions have been performed, only than would I consider a CT scan of the sinuses.

Some (other ENTs) may argue that CT scan of the sinuses should be performed early as a more directed intervention can than be performed.

My argument against that is, EVEN if the CT sinus comes back abnormal, I STILL would perform the above interventions first because often the above interventions will clear up and sinus abnormality seen on a CT scan.

Only when everything else has been tried would I consider sinus surgery in a child and only than would a CT sinus be justified in my mind.

However, there are certain other situations I may consider getting a CT scan relatively quickly...

• If I find a sino-nasal mass on exam concerning for tumor or nasal polyps
• Congenital hearing loss
• Cholesteatoma (tumor of the ear)
• "Significant" Facial Trauma (ie, not just for a simple broken nose)


Reference:
Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet. 7 June 2012. doi:10.1016/S0140-6736(12)60815-0

Source:
Children's CT Scans Pose Cancer Risk. Wall Street Journal 6/6/12

Dental X-rays Linked to Brain Tumors

In a study spanning over decades, researchers have found an association between dental x-rays and increased risk of a non-malignant type of brain tumor called meningioma.

Of the four types of dental x-rays, only the full-mouth series was associated with this increased risk. More specifically, the risk was elevated with the aggregate number of full-mouth series in 10-year periods from approximately 15–40 years before diagnosis, with significant elevations in the 10-year periods beginning 22–30 years before diagnosis. The risks in these analyses were even greater when only women were considered.

One needs to be aware that radiation exposure from full-mouth series was much greater in the past than it is now and as such, this risk may be nominal (though not zero) with current dental x-ray technology.

However, it also should be a reminder that x-rays should not be routinely performed unless there is a very good reason to obtain especially in children who are more susceptible to radiation injury... and that applies to not only x-rays, but any kind of testing involving ionizing radiation including CT scans.

Some x-rays should NEVER be performed including sinus x-rays for sinus problems given a nearly 50% error rate in diagnosing the presence OR absence of sinus problems.

X-rays for nasal fractures is not recommended given x-rays rarely change how such fractures are managed.

Soft-tissue lateral x-rays to look for large adenoids should also be discouraged as nasal endoscopy can provide similar if not better information without any radiation exposure.

To know what the cancer risk is with different types of x-rays, check out this website!

Source:
Dental X-rays and the risk of intracranial meningioma. Cancer. Volume 100, Issue 5, pages 1026–1034, 1 March 2004

Surgical Time-Out, circa Year 2050

In the year 2050, surgical time-outs have reached a new level of safety to ensure the utmost care and risk reduction for patients.

Unlike the primitive time-outs performed in the the first decade of the 21st century (2000-2012) which involved one designated individual to confirm prior to incision (Basic9), the patient name, surgical site, performing surgeon, allergies, antibiotic administration, positioning, x-ray name confirmation, fire hazards, and fall risk, significant additional safety checklists have been implemented to create a new state-of-the-art culture of safety both in and out of the operating room.

In 2015, surgical time-outs extended to also include electrical and air quality checks (Environ2) along with separate mandatory time-outs of the Basic9 before, during, and at conclusion of surgery.  To ensure minimal air contaminants as well as maintain the highest performance of all electrical equipment in the operating room, the Environ2 requires a separate electrical and environmental engineer to certify all equipment and confirm air quality at a level of no more than one contaminant part per trillion to the 10th power in 35 separate locations within the operating theater. The Environ2 checks are double-confirmed by the circulating nurse who has been granted broad powers to cancel surgery for any reason without consequence if there are any concerns with the operating room environment that may increase infection risk for the patient as well as sub-optimal performance of any and all equipment used to perform the surgery.

In 2020, the Total5 was added to Basic9 and Environ2 which truly heralded the onset of state-of-the-art surgical time-outs. Total5, developed jointly by the Harvard School of Public Health and National Institute of Medicine, involves a comprehensive time-out of any and all individuals entering into the operating room in the knowledge that surgical outcomes are affected by personnel movement into and out of the operating room whether from contaminants on the skin or clothing of staff to infections that they may or may not be harboring. In rare cases, given the recent terrorist attacks both biological as well as chemical, the Total5 would additionally eliminate such threats.

As such, Total5 involves for each and every staff member that enters the operating room to undergo "individual time-outs":

1) Geiger counter check

2) Body pat-down by TSA (whose duties have tremendously expanded from initial airport security)

3) Metal detector check

4) Chemical check (specifically looking for arsenic, mercury, formaldehyde, etc as well as drug screen)

5) Biohazard check (routine organisms include MRSA, VRSA, C dif, HIV, hepatitis, etc as well as more exotic organisms like Ebola, Swine Flu, Anthrax, etc).

A separate consent must be in the chart for each and every individual who is present for the patient's surgery with their Total5 report.

The Basic9, Environ2, and Total5 surgical time-outs collectively have ensured a 360 degree safety net for the patient.

But... it is not until now in the year 2050 that the surgical time-out has reached a penultimate state with the expansion of the Total5 to Total10. In addition to the original Total5 for surgical staff, 5 additional time-out checks of surgical staff is now required. Continuing with #6...

6) Retina scan (to confirm staff identity)

7) Fingerprint scan (to double-check staff identity)

8) Malpractice insurance check (if positive, consent must be in chart to ensure patient was aware of any malpractice committed by any surgical personnel doctor or nurse)

9) EKG to ensure peak cardiac health of staff member

10) EEG to ensure a rested mind at peak performance of staff member

As with the Total5, Total10 report for each staff member must be included in the patient consent in the patient's chart.

There was some confusion whether each staff member can undergo just one Total10 per day, but with new regulation acknowledging possibility of patient infection contaminating personnel as well as staff member fatigue that may progress throughout the day, a Total10 MUST be performed before each and every surgical case.

For any further questions on surgical time-outs, please contact your local hospital JCAHO executive liaison.

Sleep Apnea Surgery Malpractice Lawsuit

In November 2009, a patient underwent multi-level surgery to treat her mild-moderate obstructive sleep apnea by a Houston, TX otolaryngologist.

The surgery included:

• Uvulopalatopharyngoplasty (UPPP)
• Tonsillectomy (typically considered part of UPPP)
• Adenoidectomy
• Hyoid Myotomy
• Genioglossus Advancement

She unfortunately experienced some unspecified complications stemming from this surgery which apparently has not helped with her obstructive sleep apnea either. A malpractice lawsuit commenced and final judgement is still pending.

Let's take a closer look at the incomplete information provided.

The patient suffered from mild-moderate obstructive sleep apnea which typically means a AHI score of around 15 (< 5 is normal).

For this level of severity, simultaneous multi-level surgery is not typically performed. Rather such extensive surgery is reserved for severe obstructive sleep apnea.

Also unclear is whether any objective studies were performed prior to surgery to try and localize the levels of obstruction that required correction. Such preoperative studies include a sedated endoscopy as well as trial of CPAP usage.

Assuming patient tried and failed to use CPAP and had objective evidence for multi-level obstruction, what did each of the surgical procedures do?

UPPP, tonsillectomy, adenoidectomy address mouth-level obstruction.

Hyoid myotomy and genioglossus advancement address tongue-level obstruction (the tongue can fall backward while sleeping causing obstruction).

Complications can occur for each of these procedures mainly dealing with bleeding, hematoma, infection, or abscess formation. Swallowing problems can also occur with the hyoid myotomy and genioglossus advancement.

Read more information on obstructive sleep apnea.

Source:
Sleep apnea surgery leads to malpractice lawsuit. Southeast Texas Record. 1/23/12

New Webpage on Thyroid Mass (Evaluation and Management)

A new webpage has been uploaded to our practice website describing the evaluation and management of a thyroid mass. Surgical removal is discussed along with risks involved.

Click here to read more!

Tall Women (Over 5'1") Have Higher Risk of Cancer!

Female models may be tall and beautiful, but they are also at markedly increased risk of developing cancer. The New York Times reported on a fascinating research article regarding height of a women and risk of cancer.

Specifically, for every four-inch increase in height over 5 feet 1 inch, the risk that a woman would develop cancer increased by about 16 percent, especially for:

• Colon Cancer (RR per 10 cm increase in height 1.25, 95% CI 1.19—1.30)
• Rectal Cancer (1.14, 1.07—1.22)
• Malignant Melanoma (1.32, 1.24—1.40)
• Breast Cancer (1.17, 1.15—1.19)
• Endometrial Cancer (1.19, 1.13—1.24)
• Ovarian Cancer (1.17, 1.11—1.23)
• Kidney Cancer (1.29, 1.19—1.41)
• Brain/Spine Cancer (1.20, 1.12—1.29)
• Non-Hodgkin's Lymphoma (1.21, 1.14—1.29)
• Leukaemia (1.26, 1.15—1.38)

It is hypothesized that the levels of growth hormone responsible for human height might also be involved in cancer development or because taller people are at greater risk for mutations simply because their bodies are comprised of more cells.

The increased cancer risk was found to be also true across Asia, Europe, Australia, and North America populations.

Perhaps now there's a reason why the average female is 5 feet, 3.8 inches tall! It's a balance between social preferences for being tall versus negative biological consequences for being tall.

The good news here (if there's any) is that head and neck cancer does not increase with height.

Read the NYT article here.

Read the research abstract here.

Reference:
Height and cancer incidence in the Million Women Study: prospective cohort, and meta-analysis of prospective studies of height and total cancer risk. The Lancet Oncology, Volume 12, Issue 8, Pages 785 - 794, August 2011 doi:10.1016/S1470-2045(11)70154-1

Kids Exposed to Fido or Fluffy in the First Year of Life Decreases Risk of Becoming Allergic to Them

There have been a number of studies in the past investigating whether it is healthy for a baby to be around pets and whether such exposure increases or decreases risk of becoming allergic to them later in life.

In a recent study (published online June 2011), the researchers found that among males, those with an indoor dog during the first year of life had half the risk of becoming allergic to dogs at age 18 compared with those who did not have an indoor dog in the first year of life regardless whether born by C-section or vaginally. Also, teens with an indoor cat in the first year of life also had a decreased risk of becoming allergic to cats. Neither cumulative exposure nor exposure at any other particular age was associated with either outcome. So it appears that the FIRST year of life is key to whether a child develops pet allergies or not.

Although in this study, cat and dog ownership appears to be beneficial in kids, prior studies have suggested that for at least cats, it increases risk of overall allergies in children by 13 times! Dog exposure, however, reduces overall allergy by 4 times.

Reference:
Lifetime dog and cat exposure and dog- and cat-specific sensitization at age 18 years. Clinical & Experimental Allergy Volume 41, Issue 7, pages 979–986, July 2011

Genetic and environmental risk factors for childhood eczema development and allergic sensitization in the CCAAPS cohort. J Invest Dermatol. 2010 Feb;130(2):430-7. Epub 2009 Sep 17

Opposing Effects of Cat and Dog Ownership and Allergic Sensitization on Eczema in an Atopic Birth Cohort. J Pediatr. 2011 Feb;158(2):265-71.e1-5.

Nasal Hair Protective Against Asthma in Patients with Allergies?

Researchers in Turkey found that there is an association between nasal hair density and risk of asthma developing in patients with seasonal rhinitis patients. No joke... They published their findings in the International Archives of Allergy and Immunology in March 2011.

The rate of asthma found in patients with little or no nasal hair was 44.7% whereas only 16.7% of patients with a dense forest of nasal hair had asthma.

They hypothesize that increased nasal hair improves allergen filtration thereby preventing the allergens from irritating the airway. The assumption here being that allergen irritation of the airway can potentially cause asthma.

IF this is true (and that's a big if)... patients with allergies should be encouraged to grow nice thick nasal hair to prevent future asthma!

Read the research abstract here!

Reference:
Does Nasal Hair (Vibrissae) Density Affect the Risk of Developing Asthma in Patients with Seasonal Rhinitis? Int Arch Allergy Immunol. 2011 Mar 30;156(1):75-80

Do Cell Phones Pose a Health Hazard? Do Cell Phone Companies Know About Them?

With all the recent news about increased glucose metabolism in the area of the brain in proximity to cell phone antennas (study abstract here), I thought it worth re-printing this blog article I wrote back in November 2010 regarding the possibility that cell phone makers may know more about health risks associated with cell phone use than they may be letting on. There's another blog article I wrote regarding what studies ARE already out there regarding risk of developing brain tumors that I felt worth re-printing below as well.

It is true that some people may find this recent research good news for some young people as it may be the only stimulation their brain gets (joking!), but it does bring some additional concerns that may merit limiting cell phone use as well as how it is used.

I quote (myself)...

Recently, there has been much speculation on whether cell phones pose a health risk.

What I find interesting is that the cell phone makers may actually know more about these risks than they are letting on or even have evidence for them.

If you look in the small print booklet that comes with your cell phone, cell phone makers state that phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around. The picture of how the Verizon ad guy is using the cell phone is exactly how you are NOT supposed to use the cell phone (cell phone pressed against the face).

For example, in the iPhone 4 small print booklet that comes in the box with the phone, go to page 5 under the section "Exposure to Radio Frequency Energy." I quote:

"When using iPhone near your body for voice calls or for wireless data transmission over a cellular network, keep iPhone at least 15 mm (5/8 inch) away from the body, and only use carrying cases, belt clips, or holders that do not have metal parts and that maintain at least 15 mm (5/8 inch) separation between iPhone and the body."

Now, when I use a phone and answer a call, I have the phone right up against my ear just like the Verizon ad guy. I do not keep it 5/8 inch away from my ear/head.

Now why would a cell phone maker care whether the phone is right up against the ear (so you can hear better) or not unless there is some concern that there may be a danger due to proximity/contact?

Perhaps they are protecting themselves from any possible lawsuit that may occur in the future due to health problems that will occur with phone use over time?

Kind of reminds me of the tobacco industry who for years denied that smoking posed any health risk. Now we know better.

It would be ironic if Paul Marcarelli, the actor of the "Verizon Guy" character, develops a brain tumor due to cell phone use and sues the wireless industry just like the family of David McLean, the actor of the "Malboro Man," sued the tobacco industry for wrongful death when he developed and died from lung cancer caused by smoking.

Something to think about...

So are there studies out there suggesting that cell phones and wireless phones can lead to brain tumors like astrocytoma, malignant gliomas, and benign acoustic neuromas? Several studies published since 2009 containing long-term (10+ years) follow-up have lent support that it does.

The group at greatest risk for development of brain tumors have the following characteristics:

1) Use of cell/wireless phone younger than age 20 (the younger the age with first use, the worse the risk)
2) Use of cell/wireless phone for more than 10 years
3) The more hours of cellular phone use over time, the higher the risk of developing brain tumors
4) Risk higher with analog cell/wireless phones (instead of digital)
5) Risk higher with increased overall total exposure

By some estimates, subjects who used cell phones for at least 10 years had a 2.4-fold greater risk of developing a brain tumor.

Though unclear how exposure to a phone's microwave radiation leads to brain tumors, it is known that the cell signal is absorbed up to 2 inches into the adult skull. Even more worrisome is that the depth of penetration is even deeper in children.

The risk is not just to the brain, but even the parotid gland which sits just in front of the ear. In one study published in 2008 revealed an increased risk of parotid gland tumors with cell phone use. Also, contact allergy is another not uncommon risk with cell phone use.

Symptoms that a patient may exhibit that may suggest a brain tumor are subtle and include hearing loss or ringing of the ear on the same side the phone is used on.

It should be noted that all currently published results are based on retrospective studies and ideally, prospective studies will be required to provide more definitive results. However, that will take a long time and perseverance on both the researchers as well as the subjects since ideally, many of the study subjects should be children who are currently using cell phones (which it seems to be nearly all kids nowadays).

In any case, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset (not wireless), or avoid altogether if at all possible, especially in children.

References:
Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011 Feb 23;305(8):808-13.

Risk of Brain Tumors From Wireless Phone Use. Journal of Computer Assisted Tomography, 2010; 34 (6): 799 DOI: 10.1097/RCT.0b013e3181ed9b54

Cell phones and brain tumors: a review including the long-term epidemiologic data. Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Mobile phones, cordless phones and the risk for brain tumours. Int J Oncol. 2009 Jul;35(1):5-17.

Cell phone use and acoustic neuroma: the need for standardized questionnaires and access to industry data. Surg Neurol. 2009 Sep;72(3):216-22; discussion 222. Epub 2009 Mar 27.

Cellular phone use and risk of benign and malignant parotid gland tumors--a nationwide case-control study. Am J Epidemiol. 2008 Feb 15;167(4):457-67. Epub 2007 Dec 6.

Wireless and Cell Phones Increase Risk of Brain Tumors

In an ongoing controversy regarding whether cell phones and wireless phones can lead to brain tumors like astrocytoma, malignant gliomas, and benign acoustic neuromas, several recent studies published since 2009 containing long-term (10+ years) follow-up have lent support that it does.

The group at greatest risk for development of brain tumors have the following characteristics:

1) Use of cell/wireless phone younger than age 20 (the younger the age with first use, the worse the risk)
2) Use of cell/wireless phone for more than 10 years
3) The more hours of cellular phone use over time, the higher the risk of developing brain tumors
4) Risk higher with analog cell/wireless phones (instead of digital)
5) Risk higher with increased overall total exposure

By some estimates, subjects who used cell phones for at least 10 years had a 2.4-fold greater risk of developing a brain tumor.

Though unclear how exposure to a phone's microwave radiation leads to brain tumors, it is known that the cell signal is absorbed up to 2 inches into the adult skull. Even more worrisome is that the depth of penetration is even deeper in children.

The risk is not just to the brain, but even the parotid gland which sits just in front of the ear. In one study published in 2008 revealed an increased risk of parotid gland tumors with cell phone use. Also, contact allergy is another not uncommon risk with cell phone use.

Symptoms that a patient may exhibit that may suggest a brain tumor are subtle and include hearing loss or ringing of the ear on the same side the phone is used on.

It is interesting to note that it is just possible that the cell phone industry is aware of these risks even as it denies any risk of health problems with phone use. If you look in the small print booklet that comes with your cell phone, cell phone makers state that phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around. Read more about this here.

However, all currently published results are based on retrospective studies and ideally, prospective studies will be required to provide more definitive results. However, that will take a long-time and perseverance on both the researchers as well as the subjects, since ideally, many of the study subjects should be children who are currently using cell phones.

In any case, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset (not wireless), or avoid altogether if at all possible.

References:
Risk of Brain Tumors From Wireless Phone Use. Journal of Computer Assisted Tomography, 2010; 34 (6): 799 DOI: 10.1097/RCT.0b013e3181ed9b54

Cell phones and brain tumors: a review including the long-term epidemiologic data. Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Mobile phones, cordless phones and the risk for brain tumours. Int J Oncol. 2009 Jul;35(1):5-17.

Cell phone use and acoustic neuroma: the need for standardized questionnaires and access to industry data. Surg Neurol. 2009 Sep;72(3):216-22; discussion 222. Epub 2009 Mar 27.

Cellular phone use and risk of benign and malignant parotid gland tumors--a nationwide case-control study. Am J Epidemiol. 2008 Feb 15;167(4):457-67. Epub 2007 Dec 6.

Avoidable Pediatric Radiation Exposure

Children and teens often get diagnostic tests that expose them to radiation, increasing the risk of cancer later in life. Over just a 3 year span, 42.5% of kids got some form of ionizing radiation from a diagnostic medical procedure whether it be a chest x-ray, CT scan, dental scan, etc. Click here to calculate the cumulative risk of cancer with each type of test.

From an ENT standpoint, common diagnostic tests that expose patients to radiation include CT scans of the head, facial x-rays, and neck x-rays.

Why would kids get such scans done?

CT scans are often performed to evaluate for sinusitis as well as to figure out what is causing chronic headaches. Neck x-rays are often done to evaluate for adenoid hypertrophy while facial x-rays are done after facial trauma to look for a nasal fracture.

It is my personal bias to avoid such diagnostics tests if at all possible, ESPECIALLY because there are alternative options.

Nasal endoscopy can be performed to evaluate for sinusitis as well as adenoid hypertrophy thereby making unnecessary the need for neck x-rays as well as CT scans. X-rays to evaluate sinusitis is NEVER indicated as it is wrong 50% of the time (click here for more info on this).

Nasal fractures are easily appreciated on exam thereby making unnecessary facial x-rays. In cases of trauma, an x-ray can be considered from a purely medico-legal documentation standpoint, but is not really necessary from a medical standpoint. Read more here why.

Read a story about this in Reuters.

Do Cell Phone Makers Secretly Know Cell Phones May Cause Health Problems?

Recently, there has been much speculation on whether cell phones pose a health risk. Wikipedia has a nice summary of those concerns.

What I find interesting is that the cell phone makers may actually know more about these risks than they are letting on or even have evidence for them.

If you look in the small print booklet that comes with your cell phone, cell phone makers state that phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around. The picture here is exactly how you are NOT supposed to use the cell phone.

For example, in the iPhone 4 small print booklet that comes in the box with the phone, go to page 5 under the section "Exposure to Radio Frequency Energy." I quote:

"When using iPhone near your body for voice calls or for wireless data transmission over a cellular network, keep iPhone at least 15 mm (5/8 inch) away from the body, and only use carrying cases, belt clips, or holders that do not have metal parts and that maintain at least 15 mm (5/8 inch) separation between iPhone and the body."

Now, when I use a phone and answer a call, I have the phone right up against my ear as shown in the picture here. I do not keep it 5/8 inch away from my ear/head.

Now why would a cell phone maker care whether the phone is right up against the ear (so you can hear better) or not unless there is some concern that there may be a danger due to proximity/contact?

Perhaps they are protecting themselves from any possible lawsuit that may occur in the future due to health problems that will occur with phone use over time?

Kind of reminds me of the tobacco industry who for years denied that smoking posed any health risk. Now we know better.

Something to think about...

I should add that most studies to date do not show any definitive long-term harm from using cell phones, though studies following patients for more than 10 years do show an association with brain tumors. The greatest consistent risk is more from contact allergy.

BUT, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset.

Having Allergies Reduce Risk of Cancer!

Well maybe... According to a May 2010 study where questionnaire-based interviews were performed and encompassed self-reported history of prior medical diagnosis of asthma and eczema, medication use, and several covariates among 3,300 cancer cases and 512 population controls, a history of asthma was negatively associated with all cancer types combined (OR, 0.72; 95% CI, 0.5-1.1) and similarly for a history of eczema (OR, 0.66; 95% CI, 0.4-1.1).

Why would this happen? Well, allergies is due to a hyperreactive immune system that may lead to a more efficient elimination of abnormal cells, thus lowering cancer risks.

More study is needed to verify if this correlation truly exists.

What I would like to see is 3 groups (allergic group treated with meds only, allergic group on immunotherapy, and control group) followed out.

Reference:
History of asthma or eczema and cancer risk among men: a population-based case-control study in Montreal, Quebec, Canada. Ann Allergy Asthma Immunol. 2010 May;104(5):378-84.

Coffee Decreases Risk of Head & Neck Cancer

Researchers at University of Utah found that regular coffee drinkers who drank more than four cups of coffee a day had a 39 percent decreased risk of two types of head and neck cancer: oral cavity and pharynx cancers. In the study published in the journal of Cancer Epidemiology, Biomarkers & Prevention, they found however, that coffee did not decrease the risk of laryngeal cancer. Coffee contains over 1,000 different chemical compounds, including cancer-fighting antioxidants, and it’s those antioxidants that may provide a “plausible explanation” for reducing the cancer risk.

However, patients should not take this study as an excuse to increase their coffee intake specifically to counteract known cancer-causing behaviors including smoking, drinking alcohol, and chewing tobacco.

Read a CNN report on this here.

Reference:
Coffee and Tea Intake and Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev, June 22, 2010; 1055-9965.

New Simple Blood Test In Newborns Can Predict Allergy Risk!

Researchers in Australia have discovered a certain protein extracted from umbilical cord blood can predict the allergy risk a given newborn has in the future. The research titled "Protein kinase Czeta: a novel protective neonatal T-cell marker that can be upregulated by allergy prevention strategies" was published in 2007 in the Journal of Allergy & Clinical Immunology. The protein called "Neonatal T-cell Protein Kinase C zeta" (PKCzeta) was lower in children who had evidence of allergic disease at 1 year (P = .001) and 2.5 years (P = .052) of age. They also determined that fish oil supplementation (4g per day in pregnant females) was associated with significantly higher PKCzeta expression (P = .014), whereas most other isozymes were reduced by fish oil supplementation.

What does this all mean? It suggests that pregnant females who ingest fish oil reduces the risk of allergy development in their unborn child.

At this time, as far as I know, the only place (outside research labs) that is able to test for this protein marker is in Australia. But perhaps it soon will become available in the US?

For now, US residents have only the skin prick or blood test RAST/immunoCAP to determine allergies.

Our office offers allergy testing by blood draw (RAST) as well as treatment with allergy shots and allergy drops.

The research abstract can be read here.

A media report can be read here.

Website That Calculates Your Cancer Risk From Radiological Tests

In the last few weeks, there's been multiple media reports on the increased risk of cancer with common radiological tests due to radiation exposure, however minimal it may be.

Due to this concern, a website called "X-Ray Risk.com" was developed that calculates your increased cancer risk based on type of test, age, and gender.

For example, a CT Neck (a common CT test ordered by ENTs) on a 35 year-old male increases cancer risk by 0.046%. A chest x-ray? Only 0.001%.

Check out the website here.

Distortion of Risk Assessment for Surgical Complications

Over time and experience as well as being exposed to some pop psychology by the likes of Malcolm Gladwell, Nassim Taleb, Ori & Rom Brafman, Robert Krulwich, Jad Abumrad, among others, I have realized that patients assess surgical risk in very different ways with most using irrational considerations.

Too often, physicians use statistics, numbers, and facts to counsel patients on risk whether it be surgical or some other medical intervention (medications, CT scan, etc). And we should. However, how patients process this information is more often based on emotive factors and anecdotal stories heard from friends, family, as well as internet.

Such "stories" whether from friends or the internet is perhaps one of my biggest allies as well as bane of my existence. Why? Because patients make decisions based on the experiences of a few individuals. Facts? Statistics? They play only a minor role. To make things worse, such stories are expressed in more negative terms than positive.

Why is that?

I think it's because people who experience a bad outcome are FAR more vocal from a perceived sense of injustice than those who experience the good (and expected) outcome.

As the saying goes, a person with a good outcome tells 1 or their friends whereas a person who has a bad experience tells 5 friends.

It is against just this kind of backdrop that patients "listen" to the statistics, but are influenced by the stories they hear.

To make things worse, risk evaluation is distorted by the lack of control patients feel. It is why there are so many people who are afraid of flying and yet have no trouble driving a car where the risk of death is MUCH higher. Or why most people are horrified by the idea of a gun in the house but won't blink twice about a swimming pool which kills far more kids than guns.

How is a physician to combat such forces in order to allow for a more reasoned decision made by the patient for a given medical intervention?

I have no solution to this problem other than to keep aware of what patients are hearing and being mindful of such emotive factors when providing counselling. In practical terms what does this mean? It means I read... a lot... and not just from medical journals either, but newspapers, magazines, blogs, and other sources that patients probably encounter before seeing a physician. Thank goodness for online news collators (Medical News Today, Topix.net, etc) as well as Twitter.

I also produce my own online literature to balance out (hopefully) the other materials that are out there, but more so in story format in layperson terms rather than factual & medical regurgitation and use of ambiguous language (where emphasis is "see your doctor" for more specific information) that plaque more reputable medical websites.